Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU

Abstract

Ventilator-associated pneumonia (VAP) is the most prevalent infection in intensive care units (ICU). To reduce this rate, the application of bundles – groups of individual practices and adherence to the best nursing practices from Association for Professionals in Infection Control and Epidemiology (APIC) guidelines (2009) is recommended. This study aimed: This study aimed to estimate the microbiology including; rate of VAP, mortality rate attributed to VAP, among (ICU) critically ill patients and evaluate the effectiveness of adherence to VAP bundle on elimination of infection, also cost effectiveness as reflection to length of stay in ICU. Subject and methods: A comparative interventional design was used to achieve the aim of the study. It is conducted in 14 bedded Adult Medical-surgical ICU.VAP Bundle Program was implemented by our multidisciplinary team (pulmonologist, microbiologist, intensivist and ICU nurses). The VAP bundle team starting the program implementation in January 2014 till the end of December 2015 (follow up prospective study), all those patients underwent daily 5 items 1- bed elevation, 2- DVT prophylaxis, 3- peptic ulcer prophylaxis, 4- oral hygiene and 5- sedation break and weaning assessment. Surveillance reports from ICU for the year 2013 were reviewed (retrospective study). Data were collected and analyzed for (VAP) and compared before and after VAP bundle intervention. Results: All ventilated patients who met the inclusion criteria were grouped in two groups, group A (130) patients non bundle used and group B (250) patient vap bundle used, then sub grouped to VAP and non VAP for statistical analysis, mean age in vap patients was higher in both groups, VAP incidence in group A 18.5% that decreased significantly to half of 9% in group B, p value <0.05, also VAP rate/1000 ventilated day showed a statistically significant difference between group A 25/1000 day in 2013 to VAP rate in 2014 year, 8.5/1000 ventilator days, also to VAP rate 6/1000 ventilator days in 2015, p value <0.007. Strong significant negative correlation between compliance of VAP bundle and VAP rate was found, p < 0.0001, VAP bundle compliance ranged from 94% to 100%. Male and medical patients were higher in both groups more than 62%, outcome improved after bundle as the death rate decreased in group B in both subgroups than that in group A, and length of stay in ICU was lowered significantly in group B about 2 days subsequently lowering the cost. Conclusion: The application of VAP bundle is a feasible reality that produces improvement in microbiological measures and nosocomal infection rates resulting in lowering mortality, shortened lengths of hospitalization and decreased medical care costs. However, education and periodic training remain a fundamental process of improving health services. VAPs were reduced by improving bundle compliance and ensuring the same standard of care to all ICU patients. Direct, on-site observation was a more accurate method of monitoring.

Keywords

• Staff education
• VAP bundle
• Mechanical ventilation
• Pneumonia
• Microbiology
• Intervention